In our image-obsessed society, people who suffer from eating disorders spend nearly every waking moment—up to 90% of their day—obsessing about their appearance, according to experts with the Eating Disorders Program at The Menninger Clinic in Houston. Roughly 40% of patients also have body dysmorphic disorder (BDD), a distorted view and exaggerated vision of their appearance. Changing this image is critical to treatment.

“Body-image disturbance is one of the most difficult things to change when treating an eating disorder and is the last symptom to resolve from treatment,” says Theresa Fassihi, PhD, a Menninger psychologist. “If a patient does not make some improvement on body-image issues early in treatment, it is a significant risk factor for relapse into the eating disorder.”

In therapy, patients participate in body-image parties, in which they must come up with one word to describe their appearance. For example, a patient may choose “grotesque” as her word. The group then gives her feedback that she is not, in fact, grotesque. She then learns the standard she has set for herself is too high and that her self-image differs from the reality of what others think of her. Patients are also challenged to come up with a positive word about themselves, not related to their appearance—something that helps them see themselves as creative, funny or compassionate.

In experiential group therapy, patients help each other trace their bodies onto paper. At the beginning of the exercise, they draw what they think they look like. Then, they contrast it with actual outlines of their body. Patients often overestimate their body size, and seeing the difference can be enlightening.

Patients “learn about how their body-image issues impact their lives, and most seem to reevaluate the importance they have been placing on appearance,” Dr. Fassihi says.

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